Findings Show Improvement in Access to Care, Reduced ER Usage

BOSTON — Five years after the enactment of health-insurance reform in Massachusetts, gains in residents’ access to needed health care have been sustained, a new survey claims. A reduction in emergency-room visits also suggests improvements in the effectiveness of health care delivery in the state.

These are among the findings from the latest Massachusetts Health Reform Survey, which has tracked the impact of reform since fall 2006. The survey, commissioned by the Blue Cross Blue Shield of Massachusetts Foundation, is the basis for “Health Reform in Massachusetts as of Fall 2010,” a report written by researchers from the Urban Institute and the University of Minnesota.

“This comprehensive assessment of health reform shows that the Massachusetts model for expanding access to coverage and needed care has held up well during some of the worst economic conditions in decades,” said Sarah Iselin, the foundation’s president. “It also shows that there’s an urgent need for the state’s health care community to address rising costs with the same level of commitment, creativity, and unified action.”

Highlights of the report include:

• Continued gains in health insurance coverage. Coverage remained at high levels in Massachusetts; 94.2{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of non-elderly adults were covered in fall 2010. This finding is consistent with the state’s health insurance survey, which estimated that only 1.9{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of the entire population was uninsured in 2010. Insurance coverage for non-elderly adults in the nation was 78.5{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} in 2010, which has declined from 80.2{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} in 2006.
• Continued gains in access to and use of health care. Compared to pre-reform levels, non-elderly adults are more likely to have a place to go when they are sick or need advice about their health. They are also more likely to have preventive-care visits, multiple doctor visits, specialist visits, and dental-care visits.
• Improvement in health status. There have been improvements in self-reported health status, with 65{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} reporting their health as “very good” or “excellent.”
• A decline in emergency-room usage. For the first time since fall 2006, there were reductions in emergency-room use, particularly in the use of the emergency department for non-emergency conditions.
• The critical role of employers. There has been a high level of employer-sponsored coverage in Massachusetts. More than two-thirds of non-elderly adults received coverage through an employer, and there was no evidence of employers or workers dropping coverage because of the availability of public coverage (commonly called ’crowd-out’).
• High support for reform. Support for health reform remained strong in 2010 at 66{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}. However, those who do not support reform have mostly shifted from neutral to oppose.
• Continued affordability challenges. The overall cost of health care, which was not directly addressed by the health-reform law, remains an issue for many. The state continues to struggle with the problem of rising health care costs and the lingering effects of the recession. More than one-quarter of adults reported that their health care spending in 2010 caused financial problems, including the need to cut back on health care services and other spending.

“The future success of health reform in Massachusetts, and in the rest of the country, will depend on the ability of policymakers and stakeholders to take on the challenge of reining in health care costs,” said study author Sharon Long of the Urban Institute and the University of Minnesota. “Massachusetts has the opportunity to lead the way here, much as the state did in the push toward universal coverage. The pre-2010 status quo of health care costs growing faster than wages year after year is not a sustainable option for Massachusetts or the nation.”